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Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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Deschutes County
Mental Health
Strategic Plan
2008-2013
May 2008
Our Mission . . . To provide high-quality and integrated
client-centered services that will enable those we serve to
strengthen their lives and roles in the community.
Deschutes County Board of Commissioners
May 28, 2008 Adoption requested
Deschutes County Addictions & Mental Health Advisory Board
May 7, 2008 Adoption
Purposes of this Strategic Plan:
1. To strengthen our organization for the benefit of our community;
2. To focus our efforts on projects and services that will benefit the people we serve; and
3. To inform and enlist the support of the public and our community partners.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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ACKNOWLEDGEMENTS
With gratitude to . . .
The staff of the Deschutes County Mental Health Department and the department’s contractors and
community partners for their dedication to the clients we serve.
The Deschutes County Board of Commissioners
Dennis R. Luke 2008 Chairperson
Tammy Melton 2008 Vice Chair
Michael M. Daly Commissioner
Members of the Strategic Planning Work Group
Dolores Ellis, Chair, Deschutes County Addictions & Mental Health Advisory Board
Chuck Frazier Addictions & Mental Health Advisory Board; Governor’s Seniors Commission
Glenda Lantis Addictions & Mental Health Advisory Board
Alison Lowe Addictions & Mental Health Advisory Board
Leo Mottau Addictions & Mental Health Advisory Board (2007Board Chair)
Roger Olson NAMI of Central Oregon Board
Lindsay Stevens Addictions & Mental Health Advisory Board (2003-2006)
Bert Swift Addictions & Mental Health Advisory Board
Contributing Deschutes County Staff
Kathy Drew Developmental Disabilities and Seniors Program Manager
Barrett Flesh Child & Family Program Manager
Lori Hill Adult Treatment Program Manager
Sherri Pinner Business/Operations Manager
Kathe Hirschman Senior Administrative Secretary
Scott Johnson Executive Director
Special thanks
To all staff, volunteers and community partners
who also contributed their time and ideas to this plan.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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TABLE OF CONTENTS
Page
Common Acronyms 4
A. Executive Summary 5
B. Overview 7
C. Our Vision, Mission, Core Values 8
D. Policies 10
E. Environmental Trends and Challenges 13
F. SWOT Analysis 17
G. 2008-2010 Work Plan 18
H. Longer Term Priorities 2008-2013
1. Consumer and Family Involvement 21
2. Organizational Development 22
3. Business Services 25
4. Program Development (General) 27
5. Child and Family Services 28
6. Adult Treatment and Support Services 30
7. Seniors' Mental Health Services 34
8. Chemical Dependency 35
9. Public Safety, Including Alternatives to Incarceration 37
10. Developmental Disabilities Services 42
Appendices
1. Financial Plan 2008-2011 43
2. Deschutes County Goals and Objectives 45
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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COMMON ACRONYMS
ABHA Accountable Behavioral Health Alliance, our five-county managed care
organization for mental health services for Oregon Health Plan members.
AMHAB Deschutes County Addictions & Mental Health Advisory Board, a community
board appointed by the Deschutes County Board of Commissioners to
advocate, plan, educate and offer guidance to the Board of Commissioners and
the County’s Mental Health department.
CCF Deschutes County's Commission on Children and Families, charged with
coordinating local services and proposing local management of State services
for children and families that can be managed more effectively at the local
level.
CDO Chemical Dependency Organization. Deschutes County Mental Health is the
CDO responsible for ensuring Oregon Health Plan members in Deschutes
County receive needed addiction prevention, education and treatment services.
DCMH The Deschutes County Mental Health department
ECOS Enhanced Care Outreach Services. These services are intended to keep people
in the community and to return Deschutes County citizens at the State Hospital
to their community; ECOS is offered through the DCMH Seniors' Mental
Health Program.
MHO Mental Health Organization (for example, ABHA).
OHP The Oregon Health Plan, the program through which many Oregonians eligible
for Federal Medicaid health services receive assistance.
PSRB The Psychiatric Security Review Board, the Board responsible for forensic
clients who have committed felonies but for reason of insanity are housed at
the Oregon State Hospital or are managed in the community by residential
programs and mental health programs such as Deschutes County Mental
Health.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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Deschutes County Mental Health
2008-2013 Strategic Plan
A. EXECUTIVE SUMMARY
Deschutes County’s Mental Health Strategic Plan, first developed in 2004, outlines projects that are
(or could be) highly beneficial to residents of this county. It includes current efforts (see the 2008-10
Work Plan) and more than 80 longer term priorities. Many cannot be completed without additional
resources, noted as “Resources needed” in the body of the text.
Deschutes County offers essential behavioral health services to the residents of our fast growing area.
These services are described in general terms in this plan. County sponsored health, human services
and public safety programs benefit children, families, seniors and others challenged by a disability,
mental illness, or addiction. Deschutes County Mental Health is on the front line of this effort to help
local residents in need.
This Strategic Plan for the Mental Health department clarifies our vision, mission and values. It
outlines an ambitious agenda in uncertain times. Our ability to be successful in carrying out this plan
will depend on the talent of our staff; the support of our County Commissioners; public funding; and
the help of our community partners, advocates and clients themselves.
How great is the need for our services? Our department helps more than 4,000 County residents
annually—adults (including seniors) with a mental illness, children with serious emotional problems,
people with disabilities, people challenged by depression or crises in their daily lives. The President’s
New Freedom Commission estimated 5-7% of adults in America have a serious mental illness and
7-9% of children have a serious emotional disturbance. Based on those estimates, as many as 11,000
people in Deschutes County need mental health services alone.
Sadly, many people do not receive help, due primarily to the lack of resources. The Oregon
Department of Human Services reports that “in Deschutes County, roughly 30 to 34% of the
people with severe mental illness are served with state and Medicaid dollars. The State does not
provide sufficient funding to allow Deschutes County to meet the entire the need for services in the
community.” Many more County residents need addiction treatment services or help in managing a
developmental disability. Some will get private or public help; far too many will receive nothing at
all.
Deschutes County and its community partners will become increasingly challenged trying to respond
to this need in our growing community. Our Mental Health department is currently using time-
limited reserves to fund some of our services. If funding is cut, difficult choices lie ahead. Who will
be eligible for services? Which services are most beneficial? What can we afford to do? How can
we change to be more effective and efficient in our work?
Our services provide a lifeline for people on the fragile Oregon Health Plan, people with disabilities
or mental illnesses and people of limited means. At best, our services stabilize and strengthen people,
offering dignity, hope, self-sufficiency—a better quality of life. Cutbacks in services risk crises,
hopelessness, costly hospitalizations, incarceration and even suicide.
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“The public mental health system in Oregon has serious problems . . . .”1 The Governor’s 2004
report, A Blueprint for Action, cites many profound shortcomings. They include a public stigma
against mental illness, significant under funding, fragmented services, an inappropriate reliance on
jails and prisons, lack of community resources, insufficient use of early intervention services and a
costly State Hospital in crisis. These seemingly overwhelming challenges are compounded by calls at
the Federal level for cuts in Medicaid funding, the critical underpinning of the Oregon Health Plan
(OHP), including mental health and addictions treatment for OHP members in Deschutes County.
On a more positive note, the Oregon State Hospital will be rebuilt and improved over the next five
years. The 2005 State Legislature also included insurance parity to treat mental health issues and
passage of a comprehensive methamphetamine initiative. The 2007 Legislature provided an
additional $1 million annually to Deschutes County to stabilize and expand our services.
Improvements include a new mobile crisis team, more addictions treatment for parents in the child
welfare system and adults in the justice system, a promising early psychosis program for young
people, new residential programs for adults with mental illness, treatment courts, and an expanded
program to help people reenter the community from jail.
In summary, this Strategic Plan provides a framework for our work over the next five years. Many of
the recommendations can be accomplished with current resources; others can be accomplished only
with new revenue. In any case, we are confident that the improvements and ongoing efforts outlined
in this Plan will be highly beneficial to our community. We invite you to become involved in this
process. Your suggestions are welcomed.
Dolores Ellis, Chair Scott Johnson, Director
Deschutes County Addictions & Deschutes County
Mental Health Advisory Board Mental Health Department
APPROVED this ___________ day of _____________________, 2008, for the Deschutes County
Board of Commissioners.
_________________________________
Dennis R. Luke, Chair
_________________________________
Tammy Melton, Vice Chair
_________________________________
Michael M. Daly, Commissioner
ATTEST:
_________________________________
Recording Secretary
1Page 7. A Blueprint for Action, Governor’s Mental Health Task Force, September, 2004.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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B. OVERVIEW
Deschutes County Mental Health has developed this Strategic Plan under the guidance of the
Deschutes County Board of Commissioners and the Deschutes County Addictions & Mental Health
Advisory Board. It is an update of the 2005-2009 Plan. The Plan extends from July, 2008, through
December, 2013. It includes recommendations that are designed to improve the department’s
effectiveness and benefit to the residents of Deschutes County.
The Plan addresses a variety of topics that affect our value to the community, the benefit of our
services and the health of our department. As a strategic document, it includes recommendations
related to our services, productivity, work environment and finances. It charts our course for the
future to help us better serve residents of our County.
Critical Background Information
Given the dynamic nature of the mental health field, public financing and community trends, a variety
of information was taken into consideration in the development of this Plan in 2005 and in its update
in 2008. These include:
• Alternatives to Incarceration Subcommittee Report to the Deschutes County Local Public Safety
Coordinating Council, February, 2007;
• Oregon State Hospital Master Plan, Phase II A Regional System to Support the Oregon State
Hospital Master Plan, Critical Community Service Needs & Plans For Central Oregon 2007-
2013, December 2006;
• Community Services Workgroup Report for the Oregon State Hospital Master Plan, March 2007;
• Oregon’s Statewide Children’s Wrap-Around Initiative Steering Committee Report to Governor
Ted Kulongoski, December, 2007
• Results of the 2005 and 2007 Oregon Legislative Session, both policy and financial;
• Results of the 2005, 2006 and 2007 Deschutes County Budget Processes;
• The emphasis on Evidence Based Practice (SB 267, 2003 Oregon Law);
• The 2003 President’s New Freedom Commission Report on Mental Health, 2003;
• The Governor’s Mental Health Task Force 2004, "A Blueprint for Action";
• Staff suggestions, including results of the 2004, 2005 and 2008 Employee Surveys; and
• Recent State, County and managed care audits of our operations.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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C. OUR VISION, MISSION, AND CORE VALUES
Our Vision
“Help is available for everyone in Deschutes County with a mental illness, developmental
disability, addiction, or short-term crisis regardless of income, culture, age or where you live
in the County. Help can be found here for children, adults and seniors in Central Oregon,
close to family and friends.
Local government and private agencies work together well and offer a system of affordable,
accessible and integrated services. For our part, Deschutes County Mental Health is regarded
as one of the most effective and helpful county mental health programs in Oregon.
Dramatic strides continue to be made on a national and state level in helping to prevent, treat
or limit the effects of mental illness, addiction, emotional distress or a disability. Locally, we
are familiar with these new developments and the most effective programs and practices. We
continue to improve our services and offer training to help local practitioners in their work.
All our services are based on the concepts of resilience, recovery, and self-sufficiency.
People are supported in living as independently as possible with the assistance of families,
friends and, when needed, public and private service agencies. Supported housing and
employment projects continue to expand and prosper.”2
Our Mission
2Note: Our vision statement includes language and concepts expressed in other documents including the President’s New
Freedom Commission Report, "Achieving the Promise: Transforming Mental Health Care in America" (July, 2003).
To provide high-quality and integrated client-
centered services that will enable those we serve to
strengthen their lives and roles in the community.
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Our Core Values as an Agency
Our clients—We believe those we serve should be involved in directing the course of the
services we provide as a component of a holistic approach to resiliency, recovery and the
betterment of their lives. We believe our clients should have access, voice and
ownership.
Our staff—We believe our staff is a valuable resource, and we promote the personal
well-being and professional development of each individual. Through continuing
education, peer review, and teamwork, we support each other in our efforts to deliver
compassionate, accountable services of the highest caliber. We value trust,
professionalism, integrity and mutual respect in all we do.
Our services—We believe the services we provide are an integral part of a healthy
community and that comprehensive care is best provided through service integration,
interagency collaboration, and partnerships with other service agencies.
Our community—We believe the services we provide should be visible and available to
those in need and that public awareness and education are key elements in community
wellness. We strive to make our services visible to the community and to deliver them in
an effective and efficient manner. We encourage feedback and use a strategic planning
process proactively to address the needs of our community.
Our Values as Deschutes County Employees
Integrity, Accountability and Respect—We expect honest, ethical and respectful interactions
with each other and with the public. We keep our promises, admit mistakes, and are courageous
in doing what’s right. Our conduct ensures that Deschutes County government earns the trust of
the community it serves.
Professionalism in Public Service—We are committed to the highest level of competence and
professional conduct. We view ourselves as stewards of a public trust and accept the higher
ethical standards to which we are held.
Effective and Efficient Use of Resources—We strive to provide cost-effective services
according to the community’s priorities. We are committed to finding solutions to problems that
use common sense, good judgment and compassion, keeping in mind what is the best outcome for
the community.
Safe and Enjoyable Workplace—We value a safe work place and one in which we are honored
and recognized for our talents and accomplishments. We value the sharing of ideas, honest and
open communication, and positive attitudes. We also recognize that humor, employed in a timely
and appropriate manner, can promote good will and stronger working relationships.
Innovation and Collaboration—We encourage fresh ideas and teamwork among employees and
between county government and the community it serves.
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D. POLICIES
1. Resiliency and Recovery
Deschutes County Mental Health promotes the concepts of resiliency and recovery for people of
all ages who experience developmental disabilities or psychiatric and/or substance abuse
disorders. Policies and procedures governing service delivery will attend to factors known to
impact individuals' resilience and recovery.
The goals of resiliency and recovery based work will be:
1. Maximized quality of life for individuals and families;
2. An ability to develop and maintain social relationships;
3. Inclusion as a member of the community;
4. Participation in community activities of the individual's choice;
5. Improved health status and function;
6. Success in work, school or living situation; and
7. An ability to measure our success in implementing this policy.
This will be achieved by providing services that are:
1. Client directed. The provider must work in partnership with the client. The individual needs
to identify goals and have control of the resources to achieve these goals.
2. Individualized and client centered. The plan for reaching goals should be designed to meet
the specific needs and strengths of each individual.
3. Empowerment. Services should be delivered to support and educate the individual to be able
to plan for and direct his/her own services.
4. Holistic. Services should encompass all the aspects of an individual’s life. Services should
address client identified needs such as housing, employment, community participation,
transportation, family involvement, education and treatment for health, mental health and
addiction issues.
5. Strengths based. Providers must work with clients to identify the inherent strengths of each
individual and build on those strengths to achieve the identified goals.
6. Peer support. Services should be designed to encourage peer support including sharing of
experiential knowledge and social learning.
7. Respect. Respect should be the basis of all relationships with clients. Treating each
individual with respect, working to ensure that the individual's rights are protected and
working to eliminate discrimination and stigma will assist the individual to regain or maintain
his/her self-respect and encourage the individual's participation in all aspects of his/her life.
8. Hope. Services should convey the motivating message of a better future. Both the client and
the provider need to believe that things can get better, barriers can be overcome and goals can
be achieved.
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2. County Role as the Local Mental Health Authority
Under Oregon Law, Deschutes County is a “Local Mental Health Authority.” As a matter of
policy, the Deschutes County Board of Commissioners names the Deschutes County Mental
Health department (DCMH) as the County’s Community Mental Health Provider. Acting in that
capacity, DCMH will provide or contract for critical community behavioral health (addictions
and mental health) services and functions as well as core developmental disabilities services as
funded and assigned.
3. A Community System of Care
As a matter of policy, Deschutes County supports the concept of a Community System of Care
through which residents of our County have local access to a range of mental health services,
addictions treatment and services for people with developmental disabilities. On a case-by-case
basis, it is understood that an out-of-area placement may be most beneficial though it is not
usually as beneficial as an effective local option that allows continued family and community
involvement and a smooth transition to local services and supports.
4. Strategic Plan and Biennial Plan as Core County Documents
As a matter of policy, the Strategic Plan and the Biennial Plan put forth a set of principles,
policies, priorities and positions that are intended to reflect the direction of the Deschutes County
Board of Commissioners (the Board). Within statutory or County guidelines, the Director and
Deschutes County Mental Health will support and promote the principles, policies and priorities
contained in these plans, subject to any further direction or guidelines set forth by the Board. A
Progress Report on our success in implementing the Strategic Plan shall be provided to the Board
at least biennially.
5. Priority Populations for Deschutes County Mental Health Services
As a matter of policy, Deschutes County will focus its resources on mandated clients 3 and people
facing an imminent or emerging crisis. Within available funds, the County will provide
behavioral health care to County residents who are indigent and have no other access to urgently
needed mental health and addictions services and help for people with developmental disabilities.
Services will be offered to people who lack resources, seek services and are challenged by a
serious mental illness and/or addiction. For County residents who do not receive services,
Deschutes County will make every effort to refer people to other services in our community.
3Examples of mandated clients: Oregon Health Plan members assigned to Deschutes County (for addictions and mental health
treatment), eligible children and adults with developmental disabilities, and prioritized populations associated with Federal, State
or local grants.
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6. Regional Focus When Beneficial
As a matter of policy, Deschutes County, through its Mental Health department, will use a
regional approach to program development, direct services, resource management and advocacy
when the Department determines that the benefit to our County outweighs any associated costs.
Criteria for assigning benefit to a regional project include a) a tipping point whereby we can
accomplish something that could not be done as a single County, b) an ability to increase
resources and expand services, c) better coordination with regional entities (e.g., Cascade
Healthcare), d) greater efficiency, and/or e) improved education and advocacy. These initiatives
will often, though not exclusively, focus on Central Oregon counties but only with the mutual
agreement of all parties. Whenever Deschutes County Mental Health takes a regional approach
to its work, department staff will identify the benefit of regionalization.
7. Signature of Contracts, Amendments and Agreement
As a matter of policy, the County Administrator and the Director of Deschutes County Mental
Health are charged with implementing the County’s Mental Health Strategic Plan, as adopted by
the Deschutes County Board of Commissioners. Responsibilities of the County Administrator
include signature of related contracts, amendments and agreements. Responsibilities of the
Director include day-to-day management of the department, signature of appropriate contracts or
amendments (within County guidelines) and implementation of Strategic Plan priorities.
8. Public Safety Including Alternatives to Incarceration
As a matter of policy, Deschutes County will seek to develop a comprehensive prevention,
treatment and public safety system that is balanced and that supports best practice programs and
community involvement. The County seeks to provide sufficient jail capacity and in-jail health
services (both current and planned) as well as the best possible behavioral health services 4 pre-
and post-adjudication. In keeping with our efforts to support public safety and health care access,
the County will develop effective programs for people with mental illness and/or addictions that
come in contact with our public safety or treatment systems. For our growing community, the
County will use its resources to expand both public safety and treatment services over time.
4Behavioral health services are defined as a combination of mental health and addiction screening, assessment, treatment, case management and
other support services offered by and through the resources of Deschutes County.
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E. ENVIRONMENTAL TRENDS AND CHALLENGES
Many trends and challenges affect our work and our effectiveness. All need to be taken into
consideration as we plan for the future.
POPULATION
1. Seniors (Senate Bill 781)—Deschutes County is recognized throughout Oregon for our seniors'
mental health services and the work of this team. With changing demographics, our staff face
increasing demands and need greater support and assistance. Oregon’s population age 65 and
older is expected to rise by 33% from 2005 to 2015 while the general population is expected to
increase only 13%.
2. Equity—With the passage of HB 3067, population growth was considered in Oregon’s 2007-
2009 funding of community mental health. This requires continued advocacy, particularly if
there is a downturn in the Oregon economy.
MANAGERIAL TRENDS
3. Behavioral Health Integration—There is growing recognition that co-occurring disorders are
common and should be treated in an integrated fashion. Administratively, there is merit in
linking our Chemical Dependency and Mental Health organizations if feasible.
4. Emergency Preparedness—Each County’s mental health program, including Deschutes County
Mental Health, is expected to play a leadership role in designing and coordinating a behavioral
health response to disasters. During such emergencies, help is needed for vulnerable populations,
first responders, other caregivers and the general public.
5. Health Care Integration—Our community is benefiting from improvements in health care for
low-income individuals including Volunteers in Medicine and the Bend Community Clinic.
Development of a federally qualified health clinic in La Pine is on the horizon. Cross referrals
are critical, and our current ability to respond is limited.
6. Public Confidence and Results—All publicly financed services face increasing pressures to
perform at a high level with limited resources and to demonstrate that funds are used effectively.
We continue to seek better ways to inform the public about the benefit of our work.
7. Transportation Problems—The region’s limited ability to solve public transportation problems for
our residents means services must be offered in each community in Deschutes County. Some
progress has been made, but more is needed. We must continue to offer services locally in
several communities in the county.
8. Audits—We are nearing completion of many recommendations from six external or internal
audits in 2005 and 2006. Our Audit Action Plan contains these recommendations. A Medicaid
Audit is now underway.
9. Contracting—Greater accountability is needed for contracted services. County policy requires
attention to detail in the preparation and execution of contracts. Greater monitoring is also
needed to assure performance.
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10. Documenting Services—Billing and assuring continued Oregon Health Plan funding sufficient to
help our community depends on our ability to document delivered services and costs completely
and in a timely manner. This documentation affects actuarial calculations for Oregon MHOs.
11. Paperwork—Our clinicians raise legitimate concerns about the required paperwork and the
associated time demands. Efforts are ongoing to meet governmental regulations and reporting
requirements while asking staff to maintain a high level of direct service time. This issue is
threatened by Medicaid audits and documentation requirements.
12. County Goals and Program Budgeting—Beginning in 2007, the County Commissioners have
established County Goals; our department will focus on several of these. The goals and a move
to “program budgeting” will need our attention over the next several years.
13. Developmental Disabilities—The role of County government in offering services to people with
developmental disabilities is under review in a number of Oregon counties. The outcome of this
review is uncertain. Our Developmental Disabilities (DD) program has been a core function and
set of services in Deschutes County for many years. We will need to monitor this discussion and
will likely encourage a strong role for counties, provided we receive sufficient State funding to
perform all required duties.
14. Evidence Based Practices/Programs (EBP)—Our services must continually evolve based on
research and improvements in behavioral health care practice. We will adapt as circumstances
warrant. Documentation of our EBP work is required in Oregon law.
15. Competitive Salaries and Benefits—Over the next five years, all County positions are being
reviewed to evaluate (and increase as needed) pay rates. As part of this process, the Mental
Health Specialist II salary range was increased in 2008, benefiting 40 employees.
16. Safety Plan for the Workplace—During 2007, the Bend Police Department assisted DCMH by
evaluating the physical work place at the main clinic (Courtney) and the Annex location.
Improvements in the facility and our procedures are needed in 2008.
HEALTH CARE REFORM
17. Children’s System Reform—Managed mental health agencies in Oregon are changing services
for children with significant mental health needs. This remains an important but difficult
transition for families, agencies and counties. We lost the local services of Trillium Family
Services; we’re hoping for an expanded role for Cascade Child Center. It’s our goal to reduce
residential care while offering intensive community options for families.
18. Resiliency and Recovery—There is a national movement to promote "recovery" in the design and
delivery of services. The goals are to engage clients as full partners in the treatment process and
to develop services that promote healing, independence and support. We want to translate our
support of resiliency and recovery into concrete programs and services.
19. Managed Care—Change is inherent in managed care, much of it based on actions at a Federal
level. Our Strategic Plan assumes continued participation in the Accountable Behavioral Health
Alliance (mental health; five counties) and operation of our single-county Chemical Dependency
Organization (alcohol/drug treatment services).
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20. Health Care Reform—The Healthy Oregon Act (SB 329, 2007) resulted in the formation of
Oregon Health Fund Board and an initiative aimed at expanding access to health care and the
pooling of health care resources. Recommendations are expected from the Board in the fall of
2008. National changes are even more difficult to predict.
21. Parity Law Being Implemented—With the passage of parity legislation, health care organizations
in Oregon are now adjusting for an increase in demand for services. For DCMH, this could result
in increasing competition for behavioral health care professionals.
RESOURCES
22. The Economy in Oregon—There is an emerging concern that Oregon and our nation may face a
significant economic downturn in the next few years. Given Oregon’s tax structure, this could
reduce State resources for mental health and other social services.
23. Inpatient Costs—With improvements in our acute care system and limited access to long-term
care programs in the State of Oregon, we are incurring greater costs for inpatient services. A
more proactive management of the use of these services will be needed if we are to control these
costs and the impact on other services. We will also need to advocate for State resources and
access to State services.
24. Electronic Records—There is an increasing trend toward the use of information technology,
reduced paper and greater efficiency. This is encouraging but carries inherent costs, training
needs and adjustments for staff.
25. Cost of County Services—Charges to our department for County services affect our resources for
direct services and the amount of care we can provide. Controlling these costs wherever possible
is critical to our future and our level of service.
26. County and State Revenue—For the first time in ten years, the County’s General Fund revenue
available for services has not kept pace with costs. If this continues, access to health care for
indigent clients will decline. Similarly, if the State General Fund forecast is down and the State
cuts funding for behavioral health care, access to health care for indigent clients will decline.
27. Health Insurance—Rising costs affect the amount of service we can provide. The most
significant cost increase for our department is the rise in health insurance for County employees,
up 17%5 annually from 2002-2006. Costs were contained to 4.5% in 2008-2009, an encouraging
change.
5The 17% reflects the actual increase for Deschutes County Mental Health.
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NEW INFORMATION
28. Medicaid—Funds to help Oregon Health Plan members have stabilized in the past year but could
decline as some call for cuts in Federal entitlement programs. We need to monitor the national
debate and stay in contact with Federal officials. State and Federal auditors are seeking
repayment of funds when they determine insufficient documentation and compliance with
regulations. Repayments could be large.
REGIONAL FOCUS
29. Regional Work—Many of our challenging community issues and service needs are best
addressed in partnership with Crook and Jefferson counties. Examples: a) partnerships with
NAMI of Central Oregon, b) acute care, c) housing/residential programming, d) advocacy and
public education, and e) intensive children’s mental health services.
30. Oregon State Hospital—Community Investment?—Two new State Hospitals may be opened in
the next five years. The State is planning for shorter stays and greater focus on forensic and
geriatric populations. Will Oregon develop and finance the necessary helping systems at a
community level? There is great concern that the Oregon legislature will fail to adequately fund a
public, community-based mental health system.
ACCESS
31. Acute Care Locally—Cascade Healthcare Community has expanded services in Central Oregon,
including Sage View and Psychiatric Emergency Services beds (five) at St. Charles. This is
beneficial but carries inherent costs and requires a high level of case coordination, collaboration
and financial planning. We lack respite care options. We are impacted by losses of acute care
elsewhere in Oregon (e.g., closure of acute care services at Blue Mountain Recovery Center in
Pendleton and Mercy Medical Center unit in Roseburg). County pre-commitment investigations
have increased 61% in the past 3 years.6
32. Housing Affordability; Programs Lacking—The State reports that Deschutes County has had the
lowest residential program bed capacity per capita in Oregon. Some progress is being made but
much more is needed across an entire housing continuum. Examples of progress include a)
reopening a 5-bed PSRB home in Bend, b) financing and planned County development of a 10-
bed secure facility, and c) financing for development of an 8-bed facility.
33. Jail Expansion—Deschutes County is expected to expand the jail capacity by more than 100% by
2011 or 2012. More people with mental health issues and addictions who commit crimes will be
incarcerated. Assuring coordination and collaboration on behavioral health matters will be
critical. It will be exceedingly difficult to expand mental health services at a corresponding level.
6Pre-commitment investigations: 191 in 2005-2005; 239 in 2005-2006; 307 in 2006-2007.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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F. S. W. O. T. ANALYSIS Strengths, Weaknesses, Opportunities and Threats
This analysis was completed as part of the planning process. It is intended to identify strengths to be
sustained and supported as well as challenges or problems that must be addressed or overcome.
Strengths
• Committed, knowledgeable, trained and
motivated staff
• Community partnerships with many government
and nonprofit groups
• A cohesive Management Team
• Improvement in staff morale
• An understanding of core services within staff
teams
• Community and school based services
• Involved and supportive Advisory Board
• Long standing Board of Commissioner emphasis
on the County’s role in providing and supporting
social services for county residents
Weaknesses (internal)
• Extended wait list for services
• High need and service demand
• Not enough staff to meet needs nor
support staff help for clinicians
• Turnover in employees and related costs
• A need to embrace gradual change aimed
at improvements
• A need to improve organizational systems,
policies, and protocols
• Contract monitoring and reporting
• Greater confidence in billing system
• Chart and scheduling requirements
consistently met
• Staying well connected as we grow
• Use of panel providers
Opportunities
• Technology for electronic information system
• SB 329 and any potential for health care reform
at the State or Federal level
• ABHA examination, strengthening our managed
care work
• Using our experience with the DD system to
improve our MH system
• Greater stability through a sustainable business
plan and long-range planning
• Evidence Based Practices; local work on
practices we deem most beneficial
• New partnerships for individualized, wrap-
around services for children
• Rewriting of Oregon Administrative Rules
• Trend toward delivering services differently (e.g.,
group work, Children’s System of Care)
• Any opportunity to eliminate "silos" or restrictive
funding streams
• Revenue opportunities
• Programming to help people with mental illness
in criminal justice system
Threats (external)
• Medicaid audit and any required
repayment to State or Federal government
• Instability and reductions in County, State
and Federal funding
• Greater responsibilities associated with the
County infrastructure
• State documentation requirements
resulting in excessive paperwork for direct
service staff
• Health care costs and the impact on our
cost of doing business
• PERS resolution in the Courts; the
ongoing cost of retirement system
• Uncertainty that the State will make the
necessary changes and provide sufficient
support
• ABHA changes in the near term
• Insufficient transportation system for
clients
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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G. 2008-2010 WORK PLAN
Goal 1: Health care services for high need clients—Sustain and expand critical community
services to Deschutes County residents.
• Emergency Preparedness—Adopt a County behavioral health plan by December, 2008. Include
staff readiness; help for vulnerable populations and first responders. Department-wide.
Resources needed.
• Cultural Competence and Service—Develop strategies to help people of color; emphasize the
Latino community. Department-wide. Resources needed.
• Children’s Mental Health Services—(a) Develop the Early Assessment and Support Alliance
(early psychosis) (28 young people). (b) Sustain therapeutic service levels, including in at least
25 schools as well as safe school assessments. (c) Provide therapeutic services to victims of
abuse and neglect and analyze treatment capacity for the KIDS Center. (d) Offer community-
based clinic services and mediation assistance for divorcing families with children. Child and
Family Services. Resources needed: school services.
• Children’s Intensive Services—Help 40-60 children with significant mental health needs.
Provide community options through wrap-around services, respite options, therapeutic foster
homes and intensive community services. Support Tamarack Center development and day
treatment options. Maintain low use of psychiatric residential treatment. Child and Family
Services.
• Acute and Crisis Care—Increase Crisis Team services. Analyze trends for commitment
investigations and civil commitments. Evaluate performance of new Mobile Crisis Team.
Sustain Sage View and Psychiatric Emergency Services indigent care. Begin to develop crisis
respite option(s). Adult Treatment and Support Services. Resources needed: respite.
• Chemical Dependency—Increase addictions treatment services for indigent adolescents with an
emphasis on North and South County. Child and Family Services.
• Chemical Dependency—Increase treatment services for adults in the justice system, parents in the
child welfare system, adults with co-occurring disorders. Adult Treatment and Support Services
• Chemical Dependency—Work with our CDO, the State and ABHA to blend Medicaid funds to
help people with co-occurring disorders. Adult Treatment and Support Services.
• Chemical Dependency—Work with providers to improve referral process for court-referred
County residents who were convicted of driving under the influence.
• Justice Services—Expand alternatives to incarceration with jail expansion. (a) Assist with jail
mental health program planning. (b) Participate in jail Reach In Program. (c) Expand Mental
Health Court (25 clients) and Bridge Program (75 clients). (d) With Sheriff, expand addictions
treatment during and after jail stay. (e) Sustain Family Drug Court. (f) Continue law
enforcement training; support Crisis Intervention Training (CIT). Adult Treatment and Support
Services. Resources requested for Bridge and Mental Health Court in 2008 County Budget
Process. Resources needed for CIT.
• Employment—Expand staffing and Supported Employment services (65 clients). Adult
Treatment and Support Services.
• Housing—Increase County’s bed capacity. (a) Help Telecare develop 10-bed secure and 8-bed
residential treatment programs. (b) Help Springbrook reopen a 5-bed home (forensic clients). (c)
Help Housing Works develop transitional housing for people with mental illness. (d) Develop a
DCMH housing specialist position by 2009. (e) Expand supported housing and homeless
outreach if possible. Adult Treatment and Support Services. Resources needed for supported
housing, homeless outreach, transitional housing and housing vouchers.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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• Veteran’s Services—Initiate improved coordination regarding community services to veterans.
Adult Treatment and Support Services.
• Developmental Disabilities—Expand case management and respite services for DD clients and
their families. Participate in State discussions of County role(s) in DD services; promote primary
role for County in planning, services coordination and quality monitoring. Expand the number
and expertise of residential resources to allow individuals to remain in the community and receive
the services they need. Developmental Disabilities Services.
• Seniors' services—Measure current and needed capacity to serve this growing population.
Participate in statewide advocacy to increase geriatric services. Document performance and
benefit. Seniors' Mental Health Services. Resources requested in 2008 County Budget Process.
Goal 2: A Healthy Workforce and Work Place—Recruit, train and support a highly qualified,
motivated and effective staff. Involve staff in strengthening our organization and services. Fairly and
consistently evaluate performance. Maximize productivity, professionalism and effectiveness.
• Work Place Improvement—Complete biennial staff survey. Use results for team and department
improvements. Report progress to staff by July, 2009. Department-wide. Resources needed.
• Cross Training—Strengthen department support through cross training of support personnel.
Business Services.
• Professional Development—With programs, conduct training survey. Set training priorities
through December, 2010. Emphasize best practice. Department-wide. Resources needed.
• Competitive Salaries—With County Administration, seek to offer competitive salaries (for
recruitment and retention). Continue reviews including reception, adjust as needed. Business
Services. Resources needed.
• Work Place Safety—Assess work place safety for staff, volunteers and clients using results of
Bend Police review and other information. Develop and implement protocols and training as
needed. Department-wide.
Goal 3: Resiliency and Recovery Based System; Client and Family Involvement—Encourage
clients to take control of their lives and participate fully in the community 7. Actively involve clients
in services, program development, evaluation, education and advocacy.
• Resiliency and Recovery—Promote resilience, recovery, and self-sufficiency for our clients.
Include client recovery goal(s) in treatment plans and progress notes. Department-wide.
• NAMI—Collaborate with NAMI of Central Oregon on projects of mutual interest including the
Peer-to-Peer Program and training for law enforcement. Department-wide. Resources needed.
• Participation and Leadership—Continue participation of clients and family members on decision
making committees and involve them in the hiring process for new staff. Promote and support
consumer leadership through continued support of People First and Self-Advocates as Leaders
training opportunities. Seek to implement recommendations from 2008 consumer planning
project. Department-wide.
• Consumer-Led Service—If feasible, implement recommendations contained in the 2008
consumer planning project.
• Evaluation—Emphasize client involvement in quality improvement. Review State's OHP client
satisfaction survey results. Gain feedback from non-OHP clients as well. Business Services.
7Paraphrased from Partners in Crisis, an advocacy and education group seeking to improve services for people with mental illness
at risk of contact with the justice system
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Goal 4: Accountability, Access and Public Benefit—Strive for excellence. Emphasize best
practice, compliance, quality improvement, and productivity. Complete Audit Action Plan, conduct
outreach, offer local services; reduce wait lists and no shows where possible.
• Access—Continue to assess public access to our services, recognizing the transportation
difficulties faced by our clients. Seek equitable access for indigent and OHP clients in north and
south county. Re-examine mobile crisis region in 2009. Participate in plans for a County campus
in Redmond. Sustain school services (Redmond and La Pine). Seek resources to serve seniors in
the most convenient appropriate location for the client. Department-wide. Resources needed.
• Medicaid Compliance (Medicaid Work Group)—Assure compliance with Medicaid rules (2007
Fraud & Abuse Training). Consult with ABHA and State agencies. Manage project through a
DCMH Medicaid Work Group. Department-wide. Resources needed.
• Contracting—Improve DCMH document management and contract monitoring. Develop a
contracts specialist position. Business Services. Resources needed.
• MMIS Replacement—Participate in Oregon’s upgrade of its Medicaid Management Information
System (claims processing/provider payments). Use new system in 2008. Assure DCMH
systems and processes interface effectively. Business Services.
• Community Report—Publish an annual report on our services and performance. Department-
wide.
• Web Site—By June 2009, update Department web site; include service, performance, and
resource information. Consider use of Network of Care system. Business Services. Resources
needed.
• Performance Review—Use a quality improvement process and review of service data quarterly
(including client care rate, quality measures, chart improvements, complaints and critical
incidents, OHP penetration rate). Department-wide.
• Electronic Records—With programs, initiate 2008 needs assessment. Identify software options
that meet our needs and resources. Complete feasibility study and business plan in 2009.
Consider acquiring a new information system to support treatment, reduce paperwork, document
services and secure revenue. Business Services. Resources needed to implement.
• Licenses—Complete state processes to renew service licenses including alcohol and drug
treatment and prevention (June, 2008), mental health treatment services (June, 2008) and
children’s intensive services (September, 2009). Department-wide.
Goal 5: Sustainability, Stewardship and Resource Development—Sustain core services, meeting
the needs of a growing community whenever possible. Manage resources wisely and balance our
budget while meeting legal and contractual obligations.
• New Funding—Work with the County; seek new resources for school-based services, alternatives
to incarceration, and seniors' mental health services. Child and Family Services, Adult Treatment
and Support Services, and Seniors' Mental Health Services. Resources needed.
• Sound Financial Management—Prepare 2008-10 budget in support of Strategic Plan. Update the
three-year financial plan semi-annually; use operating funds and reserves to balance the budget
and cover essential costs. Develop contingency plans. Business Services.
• Patient Fees & Billing—Assess our fee scale and policy. Assure patient fees are calculated
accurately; analyze and strengthen our collection process and billings. Business Services.
• Encounters—With programs, assure services are documented accurately and (where possible) at
levels that meet or exceed revenues used. Each spring; calculate service unit costs based on
expenses and within Medicaid rules. Business Services
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H. LONGER TERM PRIORITIES 2008-2013
1. Consumer and Family Involvement—Actively involve clients and family members, where
appropriate, in the course of treatment, case plans, the design and development of new services
and projects, community planning and advocacy.
a. Individualized Plans of Care—Continue to improve written plans of care for all DCMH
clients. The plans will be written within 45 days of opening.
1) Each plan will address the expressed needs and preferences of the individual and that
person’s family and community support system.
2) Each plan will support the resiliency and recovery of each individual.
3) Each plan will be holistic, integrating the planning and delivery of services and support
available from various agencies, programs and natural supports.
4) The clinician and client will complete the treatment plan collaboratively.
5) Plans will be reviewed and updated as needed, but at least semi-annually.
6) System will include strong clinical supervision and charts reviews.
b. Satisfaction—Implement an assessment and satisfaction policy and process through:
1) Outcome analysis (currently through the Oregon Change Index tool);
2) Client satisfaction survey conducted periodically by the State of Oregon;
3) A feedback form available to clients and caregivers at all program locations;
4) Quarterly review of complaints and grievances; and,
5) Full participation on all advisory boards and committees.
c. Resiliency and Recovery—Explore methods to better orient the local mental health system
toward resiliency and recovery. Dedicate staff time to this effort; encourage family members
and clients to share responsibility.
d. Representation—Seek consumer and family involvement on advisory, planning, evaluation
and policy boards and committees.
e. Leadership—Continue to support consumer operated and directed efforts. Review and
implement, as feasible, recommendations from the 2008 Consumer Initiative (Report
scheduled for release June, 2008).
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f. NAMI of Central Oregon—Collaborate with the local chapter of NAMI whenever possible.
Meet regularly with NAMI representatives. Make clients and family members aware of the
support offered by NAMI and the benefit of NAMI's Family-To-Family, Peer-to-Peer and
other training and education programs.
g. Consumer and Family Advocates—Create department position(s) to help assure consumer
and family needs are represented in our system and services. Track the progress of peer-
delivered services in Benton County and elsewhere. Implement peer-delivered services, at
least on a pilot basis, in Deschutes County no later than 2009. Resources needed.
2. Organizational Development (See also Business Services.)
a. Audit Action Plan—Implement recommendations in periodic State, County or Federal audits
of the department.
b. Resource Development—Sustain and increase funding to support our priorities:
1) Encounters—Continue documentation of all encounters (i.e., services provided),
including to Oregon Health Plan members. Standard: Value of encounters should meet
or exceed revenue invested.
2) Acute Care—Work to limit crises and the need for acute care. Seek State funds at a level
sufficient to assure acute care for indigent and OHP residents of our County. Resources
needed.
3) Equity: Adequate Funding to Meet Needs—Work with the Association of Counties and
the State of Oregon to continue receiving State funds for mental health and addictions
treatment at levels comparable to other counties.
4) Third-Party Revenue—Maximize collection of revenue for services delivered.
5) State and Federal Priorities—Participate in the County process to establish Federal and
State legislative priorities. Seek opportunities to educate elected officials.
6) Grants—Secure grants to support program priorities (with County grant writer).
Priorities are set annually based on the Strategic Plan and current needs.
7) Interns and Volunteers—Market opportunities for student interns and volunteers in the
department and its programs when there is a clear service benefit.
c. Cultural Competency—Increase the public’s access to services and the quality of our services
for County residents who face language or cultural barriers.
1) Bilingual staff—Develop a bilingual (Spanish speaking) capacity within all department
programs, including reception staff. Long-term goal, resources may be required.
2) Translation of Materials—Assure that key print and web information is available in
Spanish. Note: medication instructions can be obtained from the pharmacist in Spanish;
clients should be informed about this.
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d. Evidence Based Practices (EBPs)—Continue the department’s commitment to identify and
implement proven, promising practices that are highly likely to benefit our clients and assure
compliance with Oregon law.
1) Resiliency and Recovery Model—Adopt this approach in all treatment services. Includes
adapting the model to children's services and developmental disabilities, emphasizing
resilience or maximum degree of independence.
2) Motivational Interviewing—Incorporate motivational interviewing, counseling and
enhancement in treatment services. The goal is to provide effective help to unmotivated
and mandated populations.
3) Timely Access to Help—Identify and implement the most effective ways to reduce wait
lists and assure prompt service for eligible clients.
4) Support Evidence Based Practices (EBP)—Continue current use of proven practices
(below). Assure ongoing training and supervision as needed. Use standardized modules
or fidelity scales. Monitor outcomes. Examples:
• Dialectical Behavioral Therapy
• Supported Employment
• Supported Housing
• Consumer Run Clubhouse
• School Based Children’s Services
• Motivational Interviewing
• Dual Diagnosis Services
• Intensive, Strengths Based Case
Management
• Treatment Courts
• Acceptance Commitment Therapy
• Peer-Delivered Services
5) Improved Training/Development—In priority areas as determined by a tracking of
emerging best practice services and consultation with supervisors and front line staff.
e. Staff Development and A Healthy Work Force—Recruit, train and actively support highly
qualified, motivated and effective staff, thereby strengthening our programs and our benefit
to the community.
1) Work Force Development Priorities:
• Survey staff; identify training needs periodically; act on recommendations.
• Offer training to support Evidence Based Practice priorities.
• Identify and promote the best methods to assure paperwork is current and complete.
• Make excellent use of clinical supervision and team meetings to process difficult
situations with clients.
• Offer competitive salaries and benefits.
2) Training Priorities: Training priorities will be set annually and will always include staff
development in at least one clinical service or practice.
• Offer at least two training opportunities annually.
• Six-month orientation for new employees.
• Periodic training(s) for the Advisory Board and other volunteers.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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3) Expertise—Increase support to staff by documenting and informing staff of special skills,
expertise and training of all staff members.
4) Library—Offer a library of training/education tapes and videos for use by staff,
volunteers, clients and agency partners.
5) Staff Survey—Biennially, solicit staff feedback on our operations, including
opportunities for improvement within staff teams and for the department overall. Use the
results to strengthen our work place and services.
6) Recognition—Develop methods to recognize staff for their work on behalf of clients and
Deschutes County.
7) Team Development—Support team building activities when needed.
f. Measuring Performance—Operate a quality improvement system and process to measure our
productivity and effectiveness.
1) Adopt and implement an annual Quality Improvement Plan, including performance
measures for productivity, effectiveness and quality.
2) Convene quarterly public meetings of the Quality Management Committee 8 to review
performance data. Prioritize areas for improvement.
3) Publish an annual Community Report Card to inform County residents about our services
and effectiveness including strengths and areas for improvement. Include comparative
data whenever possible.
g. Oregon Health Plan Member Services—Maintain the administrative structure necessary to
meet our managed care responsibilities. Provide high quality, accessible behavioral health
services for any Oregon Health Plan members residing in Deschutes County who need
covered services.
1) Chemical Dependency Organization—Addiction treatment and support.
2) Mental Health Organization—Mental health treatment and support, currently offered
through Accountable Behavioral Health Alliance, our five-county MHO.
3) Potential for Future Integration—Explore feasibility of integrating these organizations
and forming a behavioral health managed care organization.
h. Structure and Capacity—Critically evaluate the department’s structure to support the
Strategic Plan and the department’s services in an effective, accountable and efficient
manner. Current challenges:
1) Contract development/monitoring capability (currently insufficient). Audit finding.
Resources needed.
8The County’s Addictions and Mental Health Advisory Board serves as the Quality Management Committee.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
Page 25
2) Supervisor to direct service ratio for sufficient clinical supervision across the department.
3) Sufficient support staff help for direct service staff to maximize clinical hours (i.e., direct
service) and support necessary administrative functions.
4) Medical Director: sufficient psychiatric time for prescribing and administrative
oversight.
5) Prescriber time: sufficient time for prescribing and medication management.
3. Business Services
a. Three-Year Financial Plan—Maintain a financial plan based on operating revenue, expenses,
trends, and strategic priorities. See Appendix 1. Sustain current operations (expand where
possible) by using operating revenue and reserves. Resources, greater cost containment
needed in 2008-2013 to respond to gaps in services and a growing community.
b. County Indirect Charges—Seek methods to assure that County indirect charges do not
increase at a rate greater than operating revenue unless County general funds are available to
offset such increases 9. Resources needed if this can’t be done.
c. Sustainable Personnel Costs—By 2010, set the number of staff at a level that can be
supported with operating revenue. Adjust staff levels as needed, primarily through attrition.
On average, 10-15 positions are vacant each year.
d. Contracting Process and Support—Improve our contracts management process as
recommended by the County’s Internal Auditor. Assure we can effectively develop and
monitor department’s contracts, thereby meeting risk management and legal requirements
while investing wisely and fully in private agencies and their services.
e. Financial Management—Continue to operate our financial billing and fund management
system in compliance with County standards and practices.
1) Sound Management—Assure sufficient resources to maintain a balanced budget and fund
core services. Operate within the annual adopted budget and three-year financial model.
Adjust the three-year budget at least semiannually.
2) Contingency Fund Policy—Invest the majority of our reserves in services over the next
two to four years while operating within this new policy. Assure the department retains
sufficient reserves to remain in compliance with this policy.
f. Medical Records—Assure this critical system is operating efficiently within department
guidelines and requirements. Emphasize efficiency, capacity, benefit, compliance with State
and Federal requirements and adherence to department policies and procedures. Note:
Includes all programs and remote locations.
9Indirect charges reflect department payment for the cost of County support services including Legal Counsel, Personnel, Building Services,
Finance, Information Technology and County Administration.
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g. Electronic Records—In cooperation with Information Technology, study the feasibility of
acquiring an integrated electronic system for all clinical and business functions. Recommend
a preferred package, financing and transition plan. Emphasize ease for clinicians, utility for
treatment, scheduling, quality improvement and billing. Resources needed for development.
h. Reception Support (Main Bend Clinic and Bend Annex)
1) Centralized Scheduling—Work with Information Technology and clinical staff to assure
use of the centralized electronic scheduling system. See Electronic Records.
2) Reception—Continue to adapt and enhance reception staff's role in new client
orientations and handling of crisis and screening telephone calls.
i. Fiscal Support
1) Audit Findings—Implement internal auditor recommendations, where practical.
2) Fees—Modify client fee setting process to ensure accurate information is obtained and
appropriate fees are being set.
3) Billing—With help of Information Technology, move to an all electronic billing system
and increase frequency to bi-monthly. Goals are to save staff time and to improve
collections.
j. Capital Acquisition and Minor Equipment—Provide the necessary equipment to support
work of staff and volunteers.
1) Computer Replacement—Acquire and maintain sufficient hardware to support staff
work; acquire less costly WBTs (Windows-based terminal) whenever practical.
Table: DCMH Computer inventory
Year PCs Terminals Laptops Printers
2008 26 82 17 30
2005 26 70 9 24
2) Vehicles—Budget funds for replacement and acquisition of enough vehicles to support
our services. 2008 fleet: 20 vehicles; 2005 fleet: 22 vehicles.
3) Video Equipment—Assure acquisition and replacement of dependable, high-quality
equipment for groups and training.
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4. Program Development (General)
a. Resiliency and Recovery—Emphasize resiliency and recovery in department programming.
Use the Resiliency and Recovery Statement principles in program planning and development.
b. Improved Access to Services—Seek methods to provide timely access to services for eligible
County residents.
1) Appointments—Increase access by reducing “no shows,” particularly at time of intake.
Reduce waiting list to a maximum of two weeks for non-urgent care. Increase access
through appointment reminders, piloting of a drop-in appointment process, and reducing
the time delay between calling for and getting an appointment.
2) Geographic Proximity—Assure local access to services in La Pine and Redmond
proportionate to projected need. Emphasize residency of Oregon Health Plan members
and eligible indigent clientele. Determine need in Sisters. Resources needed.
3) Orientation for new clients—Expect each program to offer frequent orientations for new
clients at times and in a manner convenient for clients.
c. Client Chart Review Process—Conduct chart reviews at least quarterly; incorporate a peer
review process. Emphasize Medicaid regulations and State rules; prompt attention to
corrections expected. Goal: All staff meet regulations and department standards. Technical
assistance and additional reviews will be focused on staff needing more help.
d. Client Treatment Charts—Meet information and documentation needs required by Oregon
law and Administrative Rules to document critical client and service data.
1) Critical Review and Change—Reconvene a work group in 2009 to develop
recommendations to expedite paperwork, support productivity (service hours), increase
automation (using technology), assure regulatory and grant compliance, and increase our
efficiency.
2) Training—At least annually, train staff on use of the forms for quality control,
documentation and treatment planning.
e. Group Practice—Continue to offer the group modality for a variety of treatment and support
services (both successful and cost effective for many clients). Sustain and expand (where
feasible) current offerings.
f. Health Care Integration—Seek opportunities to integrate mental health services with physical
health care in our local communities.
1) Care for Low Income—Collaborate with Bend Community Clinic and Volunteers in
Medicine Clinic; assure appropriate referrals and services, where feasible, for low-
income individuals and families. Offer mental health services at Bend Community
Clinic. Resources needed.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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2) Federally Qualified Health Center in La Pine—Join in community efforts to develop a
Federally Qualified Health Clinic in La Pine; offer behavioral health services if asked.
Resources needed.
3) Latino community—work with Health Department to improve access for this community.
g. Web Site – Maintain a beneficial and accurate web site for the benefit of the community,
clients and their family members, volunteers and staff.
1) Network of Care—Improve the value of the DCMH web site. Consider using Network
of Care or another comparable service. This internet based system is multifaceted and
offers comprehensive information on mental illness, evidence based practices and
services in the local area. Resources needed.
2) Comprehensive Update—Complete a comprehensive update of our site in 2009.
5. Child and Family Services
a. School-Based Services—By 2013, expand our current service capacity to assure mental
health and addiction prevention and early intervention services are available in all public
schools in Deschutes County at least one day per week. Resources needed or services will be
reduced over time.
Table: DCMH services in Deschutes County’s public schools
2007-2008 2006-2007 2005-2006 2004-2005
Schools served 27 26 26 32
Children served Current year 473 693 546
Total public schools 37 37 37 Not available
% of schools served 73% 70% 70%
b. KIDS Center—Sustain and expand mental health services at the KIDS Center as part of a
multidisciplinary assessment and treatment system; provide services to these children in north
and south county. This is a critical community service and program priority. KIDS Center
expansion occurring in 2008 with additional medical services; additional therapeutic services
and physical space will also be needed. Oregon Health Plan (OHP) funds are essential;
community or foundation resources are needed to offer services to other indigent children and
families or therapy services will be reduced.
Table: DCMH services offered at the KIDS Center (Some services for KIDS Center clients
are provided at the Main Clinic.)
2007 2004
Children served 219 235
Hours of service 4,289 2,902
NOTE: Hours of service have gone up while number of children served has gone down due
to an increase in the complexity of the cases being seen. An increase in treatment hours per
client automatically reduces the number of clients seen overall, as each case must be resolved
and closed before opening a new case.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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c. Children’s System of Care—Continue implementation of this initiative to benefit children
(and their families) with more serious mental health needs. Emphasize OHP child members
with serious emotional disturbances. Goals: Local options, coordination with other systems;
family involvement. OHP funds are essential.
Table: DCMH services since program began October 1, 2005
Services offered Oct. ‘05-Sept ‘06 Oct ‘06-Sept ‘07 % change
Wrap-around clients 46 67 46% increase
Direct service hours 2,029 2,216 9% increase
Contacts with families 3,799 2,819 26% decrease
Hours with other agencies 1,301 1,116 16% decrease
Note: While services and number of children served have increased, the reduction in family
contacts is due to internal changes in the way staff time is documented and coded in the
computerized system. Hours with other agencies decreased as the program developed and it
was found that review, operations and management meetings were no longer needed as
frequently.
1) Central Oregon Region—Participate in Central Oregon Advisory Council, sustain
regional care coordinator position(s); expand if referrals increase; use the assessment
instrument and manage available resources.
2) System Development—Develop high-quality, evidence based, intensive community
treatment services to meet the needs of local children and families. Through our
managed care organization, provide or contract for individualized services through
private children-serving agencies based in Central Oregon. Invest in services through
Cascade Child Center, Maple Star and other providers as needed.
3) Residential Treatment—With the closure of Trillium Family Services residential care in
Central Oregon (2008) and based on best practice, reduce use of residential care where
other local options exist that are in the best interest of local children.
4) School-Linked Services—Seek opportunities to develop and expand intensive and day
treatment services in school settings in cooperation with local school districts.
5) Maximize Services; Accurate Recording (Encounters)—Consistently document all
encounters to assure availability of Medicaid resources.
d. Mediation—Sustain (or increase if needed) mediation services to divorcing families with
minor children. This long-standing program will continue to be offered in collaboration with
the Circuit Court. In 2006-2007, 81 couples received mediation services; 67% of these cases
resulted in full or partial agreement on custody and parenting time. Forty-three additional
families received consultation. This is an increase in mediations from 75 in 2004-2005.
Domestic filing fees are essential.
e. Early Psychosis—Begin the Early Assessment and Support Alliance in 2008. Help young
adults and adolescents experiencing a first psychosis. Replicate the evidence based EAST
program. Develop a local team; serve an estimated 28 Central Oregon clients. Extensive
outreach and teamwork required. State funded; continued funding is critical.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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f. Youth Suicide Prevention—Work with schools, agencies, and the community to support
suicide prevention strategies and treatment options. Continue development of the suicide
prevention project at the KIDS Center (initiated in 2007). Participate in the Suicide
Prevention Coalition, supporting the coalition’s priorities. Data: 2005: 3 youth suicides in
Deschutes County; 14 in Oregon. No suicides reported in Deschutes County in 2004 or 2003;
24 in Oregon those two years 10. Resources needed to support priorities.
g. Early Childhood—Provide staff with supervision, consultation and training to assess,
diagnose and develop appropriate treatment planning and wrap-around services for young
children with mental health needs. Increase staff awareness of services provided by other
community agencies; work with these other agencies to develop joint treatment planning to
meet the needs of young children with mental health needs. OHP and State funds are
essential.
h. Home Visits (2005 State Audit Recommendation)—Provide periodic training opportunities
for staff to allow for home visits with families (where needed and within our capacity) as part
of the therapeutic and family support process.
i. Collaboration with All Children’s Systems—Promote a value that our staff work closely with
other children’s helping systems including juvenile justice, courts, child welfare and
education.
j. Local Access in Outlying Areas—Expansion of services in north and south county in
response to access issues, community population growth and an emphasis on outreach to
Oregon Health Plan members and indigent families. Includes local services in Sisters at some
point in the future. New resources needed to meet growth in these communities. May require
redeploying resources currently located in Bend. Service Levels:
Area
Total
Population
Est’d. # of
Children 11
# children served
Jan.-Dec. 2007
Bend 77,780 17,500 681
La Pine 1,590 357 157
Redmond 24,805 5,581 348
Sisters 1,825 411 15
Number of OHP members in each area varies; services to members will remain a priority.
6. Adult Treatment and Support Services (See also Chemical Dependency and Public
Safety sections.)
a. Community Support Services—Continue to expand case management, treatment and support
services (e.g., jobs, housing) for clients with a serious mental illness. Operate within a
framework of Strengths Based Case Management. Explore the use of Positive Psychology
model to promote resiliency and recovery. Provide outreach and frequent contact with high-
need clients. Case load increase: from 185 (2005) to 300 (2007). Resources needed.
10Oregon Vital Statistics, Department of Human Services, Health Division
11Population statistics used are from the Portland State University Population Research Center. Children (ages 0-17) make up 24.5% of Oregon's
total population, and that percentage was used to calculate Deschutes County's child population.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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1) Employment (Supported)—With clients, employers, and the Vocational Rehabilitation
Dept., offer supported employment to people with mental illness. Completed 2007
technical assistance with Options of Central Oregon and successful 2007 fidelity review.
Planning 2008 expansion from 1.0 FTE to 2.75. Key recovery initiative.
2) Housing and Residential Programs—With Housing Works (HW) and others, create short-
term and permanent residential programs and housing units for people with mental illness
throughout the local area. With HW and Cascade Healthcare, opened (2005) and
continue to support Horizon House (14 units) in Bend. Assisted in reopening a 5-bed
PSRB home. Provide continued support to local foster homes. Resources needed.
A) Seek assistance of the County and cities in securing land for development and grant
funds for construction and project development.
B) Include a housing project in the County’s planned North County Service Center.
C) Expand residential programs and foster care options as well as transitional and
permanent housing for clients with mental illness.
D) Secure sustainable funding to expand homeless outreach, supportive housing and
intensive case management. Hire a housing specialist to support additional projects.
E) Develop (through Deschutes County) a ten-bed 12 secure residential treatment facility;
lease the facility to Telecare with State funds supporting operation and the lease.
F) Support Telecare development and operation of an eight-bed 13 residential treatment
facility with State financing of operational costs.
G) Participate actively in the development of a ten-year plan to end homelessness,
assuring access and benefit for special populations.
H) Promote and support residential capacity development throughout Central Oregon;
seek Jefferson and Crook counties' support of any regional housing projects operated
in Deschutes County.
See Deschutes County’s Housing Continuum
(for people with mental illness) on following page.
b. Acute Care—Work to create and sustain an effective system of acute care and intensive
service options for adults experiencing significant emotional distress.
1) Resources—Effectively invest new 2007-2009 State funding. Develop essential acute
care, case management and respite services. Sustain equitable funding achieved in 2007
(comparable to State average for acute care). Sustain access for the indigent and OHP
members to Sage View (15 beds) and St. Charles Medical Center Psychiatric Emergency
Services (five beds). Develop crisis respite as an alternative or a step down from more
intensive care. Note: Current, proposed eight-bed and ten-bed facilities will add five
longer term County-managed beds.
12Ten beds include four PSRB beds; four extended care beds and two for County placement.
13Eight beds include five extended care beds and three for County placement.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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Deschutes County’s INDEPENDENT LIVING
HOUSING CONTINUUM: Offer / expand supported
For adults with mental illness housing, case management
May 2008
(includes both facilities and services) GROUP HOUSING & SUPPORT
Emma’s Place 11 units w. voucher 14
Facility 8-12 bed @ County center 15
K e y : Facility 6-bed @ HW Redmond site
New projects or needs in italics South County project TBD
Housing First projects annually
*= regional (Central Oregon) project
DCMH=Deschutes County Mental Health RESIDENTIAL PROGRAMS
PSRB=Psychiatric Security Review Board 2 5-bed foster homes (10-beds total) in Bend
HW=Housing Works Hosmer House 5-bed PSRB home, Bend
2008: Telecare 8-bed facility 16, Bend?*
2009: Telecare secure 10-bed facility 17 Bend*
(Deschutes County development)
South county project(s)
Urgent need: short term respite 3-5 beds
TRANSITIONAL HOUSING
Horizon House 14 units Bend 18
Parole / Probation transitional facility Bend 19
2008-09: New 14-unit transitional facility Bend 20
2011-12: New 14-unit transitional facility Redmond
House of Hope – limited; $400 / month Bend
EMERGENCY SHELTER & ASSISTANCE
DCMH homeless outreach worker(s).
Need: more homeless outreach staff capacity 21
Bridge Corrections Program 2FTE; need 3rd position
Bethlehem Inn (est. 15-20 people mentally ill) *
Shepherds House *
Sage View 15-beds Cascade Healthcare Community *
Psychiatric Emergency Services 5-bed (St. Charles CHC) *
Psychiatric Emergency Service 1-bed St. Charles Redmond
HOMELESSNESS / INSTABILITY / HIGH RISK
DCMH homeless outreach worker(s)
Bridge Corrections Program 2 FTE; need 3rd position
Deschutes County jail est. 8% mentally ill (20-30 of 220)
2008: Alcohol, other drug treatment in jail and after
INFRASTRUCTURE & SUPPORT – DCMH Housing Coordinator needed
14 Emma’s Place: 9 of 11 residents have housing vouchers 11.07
15 New apartment building on site of the proposed Redmond Deschutes County Service Center
16 Residential treatment facility with 5-beds for Extended Care from State Hospital; 3-beds for County placement
17 Secure residential treatment facility with 4 beds Extended Care; 4-beds PSRB; 2-beds County placement
18 Horizon House: 10 of 14 residents have vouchers 11.07
19 Parole & Probation transitional facility: estimated 4 to 8 of the 18 beds are people with a mental illness 11.07
20 Transitional facility: $75,000 grant State of Oregon 2008; Location to be determined; Bethlehem Inn is one possible site.
21 Grant application submitted to State of Oregon Addictions & Mental Health; PENDING
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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2) Regional Council and System—With Central Oregon partners, develop a high-quality
regional system of care. Develop and sustain service options; monitor services and
finances. Continue contracts with Cascade Healthcare Community for indigent and OHP
access to Sage View and St. Charles. Actively manage use of services; authorize services
for indigent, voluntary clients; coordinate continued stay and discharge planning.
Participate in monthly utilization management meetings.
3) Oregon State Hospital(s)—Represent the interests of Central Oregon in planning for
development of the new Oregon State Hospital(s). Completed Central Oregon Plan
(2007) for regional and local service development including priority services and
estimated costs. Continue advocacy for this plan.
4) Utilization Management (UM)—Continue contract for UM Manager through ABHA to
manage and monitor use of acute care services. Provide monthly reports on use; work
with crisis staff; convene monthly regional meeting with counties and hospital to discuss
trends and difficult cases.
c. Outpatient Treatment—Provide mental health, addictions and gambling treatment. Assure
service is timely for eligible clients. Reorganized orientation process to assure access within
two weeks. Decrease no-show rates. Continue to expand services in Redmond and La Pine.
Continue to develop Dialectic Behavioral Therapy for high-need clients; sponsored three-day
training for all staff in 2007. Continue to support brief treatment where appropriate.
Caseload management (length, level of care) through clinical supervision.
d. Groups—Continue to support and expand group treatment services. Identify target
populations and diagnoses that are best treated by group services, and increase the use of
evidence based practice models. Areas of emphasis include Dialectical Behavioral Therapy,
Dual Diagnosis for the seriously mentally ill, Seeking Safety (for trauma and addictions), and
medication management.
e. Medication Management—Continue to offer critical medical services including medication
management to clients; expanding those services as client load requires. Increased
medication appointments, added nurse practitioner position (2006) and increased prescriber
time 25 hours per week. Through DCMH psychiatrist and with clinicians, offer medication
management groups (education, individual management), improving timely access. Continue
to explore the most effective and efficient use of these limited resources. Assure sufficient
medical capacity for case reviews required by Medicaid. Increase coordination with primary
care providers for ongoing medication management. Expand use of evidence based practices
within accepted department prescribing practices such as use of medication algorithms and
standardized assessment/documentation formats. Resources needed.
f. Crisis Team—Sustain new (2007) Mobile Crisis Team and evaluate use and early evidence of
benefit by January, 2009. Support development of a “crisis bag” for each member of the
Community Assessment Team and on-call workers. Staff recommendation. Each Crisis
Team member has a resource bag, and one resource bag is shared by the Mobile Crisis Team.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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7. Seniors' Mental Health Services
Deschutes County Mental Health continues to offer one of the few specialized geriatric mental
health programs serving Oregon Health Plan and indigent clients in Oregon. Over the next five
years, there is a critical need to expand services to meet the need of the fastest growing segment
of Oregon’s population. Any inability to respond to growing needs among our highest risk
elderly population will contribute to profound isolation, diminished health, costly out-of-home
placements and even suicide.
According to data compiled by Oregon's Department of Human Services, Oregon’s senior
population (age 65+) is projected to rise 33% from 2005 to 2015 compared to a general
population increase of 13%. Deschutes County’s senior population is projected to increase 63%
in that ten-year period (compared to 27% for the general population). Maintaining services, a
goal of the County Commissioners, must be viewed as at least continuing to serve the same
percentage of the need, currently 10%. The staffing to provide the services for 10% of the need
must be increased in order to keep pace with growth in the population.
Services provided by the Seniors Team
2005-2006 2006-2007
Clients 387 424
Contacts 4,512 4,386
Service hours 3,999 3,680
a. Expand Service Levels—The challenge is to provide even the same level of service to the
rapidly expanding population in need of services. The range of services must include case
management; crisis evaluations and interventions; mental health evaluations and assessments;
individual, group and family counseling; coordination with other community services and
consultation with medical providers. Continue to train and educate other elder care providers,
offer public education, play a liaison role with the State Hospital and advocate for quality
care and the other needs of seniors.
b. Geriatric Population at the Oregon State Hospital—The current population of seniors at
Oregon State Hospital is low due to the specialized services to seniors and to our Enhanced
Care Outreach Services (ECOS). ECOS keeps people in the community and allows
Deschutes County citizens released from the State Hospital to return to their community. To
continue to keep the population at Oregon State Hospital low, expansion of ECOS and other
services is needed.
c. Support Legislation (e.g., SB 1075, 2008 session)—Advocate for better access to mental
health services for seniors.
d. Enhanced Care Outreach Services—The Enhanced Care Outreach Services program has
doubled the number of clients served but is now at the absolute maximum number of clients
for the available staff. Increase staffing to keep pace with the growing number of people in
need of these services.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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e. Service Expansion—We attempted to expand services through the use of interns and
volunteers. Without additional staff hours to recruit, train and monitor volunteers and interns,
we are very limited in our ability to use these resources. Even a part-time position would
allow expansion of the volunteer and intern staff available to meet at least some of the lower
level needs at a very small cost. Resources needed.
f. Outreach—Continue the outreach model of service delivery for the seniors population. Many
seniors face significant transportation barriers, and using the outreach model allows staff to
maintain a very low no-show rate and continue to serve clients despite health, weather and
transportation issues.
8. Chemical Dependency
a. Promote a Set of Guiding Principles
1) Collaboration—Our community is best served through collaboration, a common focus
and mutual support between Deschutes County Mental Health, other County departments,
and private prevention and treatment agencies and coalitions. County will continue to
host the community Addictions Committee to help achieve this goal.
2) Investment—Treatment resources available to Deschutes County should be invested in a
manner that assures the maximum amount of high-quality services.
3) Results—Services must be based on evidence based practices and demonstrate
measurable outcomes and effectiveness. Additional work is needed in this area.
b. Comprehensive Approach—Work with the community to develop a system with a full
continuum of services to prevent substance abuse and to assure access and engagement of
those in need of addictions treatment. Resources needed.
c. Co-Occurring Disorders—Retain primary responsibility for the treatment of co-occurring
mental illness and addiction issues by DCMH clinicians. Assure qualified, well trained
professionals are offering these services. Department staff are working with state officials to
improve financing methods in support of this work. Services have also been expanded (2008)
on the DCMH Community Support Services team.
d. Equity—Successfully advocated with the State for a fair and equitable investment of
treatment resources for Oregon residents, regardless of their county of residence. Funding
inequities corrected for the 2007-2009 biennium with the passage of HB 3067. Additional
funds invested (2008-2009) in indigent care, help for adolescents, help for people in the
justice system, and help for people with serious mental illness and a co-occurring disorder.
Continue to monitor this issue and advocate so that inequities do not reemerge in 2009-2013.
e. Family Drug Court—In partnership with the courts, continue administering grants to sustain
the Family Drug Court; develop an individual Drug Court if feasible. Coordination occurs
through the Circuit Court. Prioritize families with minor children. Since inception (fall
2006), the Family Drug Court has the capacity to help 25 adults and their minor children
(currently 42, January, 2008).
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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f. DUII Service Referrals—At the request of the Circuit Court, undertake a review and
improvement in the system for offering service options to DUII clients referred by the Court.
g. County Leadership—Continue to convene treatment and prevention professionals and other
interested individuals at least quarterly to address planning, advocacy, service coordination
and program development priorities and issues. Promote and bring visibility to chemical
dependency issues. Developed the Addictions Committee as a subcommittee of the County’s
Addictions and Mental Health Advisory Board to bring better coordination and emphasis to
these issues.
h. Methamphetamine: Coordinated Response—Participate actively in the Meth Action
Coalition, supporting a comprehensive approach focused on prevention, treatment and public
safety. Seek resources to expand treatment. Resources needed.
i. Oregon Health Plan Members—Assure availability of timely, high-quality addiction
treatment services to Oregon Health Plan members through operation of the County’s
Chemical Dependency Organization (CDO).
1) Continue to assure all eligible members have access to treatment services; locally
whenever possible. Access is not currently a problem, but reductions in funding (rates)
have recently occurred.
2) Continuous evaluation of the CDO's penetration rate (percentage of members who
receive services). The formula the CDO uses to calculate the penetration rate is the
number of members who received services (numerator) divided by the CDO's adjusted
enrollment (denominator). The adjusted enrollment are members age 13 and older.
Oregon's Division of Medical Assistance Programs, along with the Addictions and
Mental Health Division, recently developed a statewide draft Alcohol and Other Drug
Utilization Report (draft was distributed in October, 2007). The CDO will take an active
role with the Addictions and Mental Health Division and Division of Medical Assistance
Programs to assist in making improvements to the statewide Alcohol and Other Drug
Utilization Report, which will provide a mechanism by which the CDO can extrapolate a
“comparative” measure of penetration in an effort to evaluate performance in this area
and target future improvement. The current penetration rate based on the adjusted
enrollment as the denominator from July, 2004, through June, 2007, is 1.5%.
3) Strengthen the coordination and integration of physical health and mental health care for
members who present for primary addiction treatment services. This will be
accomplished through the Performance Improvement Project (PIP) with Central Oregon
Individual Health Solutions (COIHS), the fully capitated health plan, and Accountable
Behavioral Health Alliance (ABHA), the Mental Health Organization. Both COIHS and
ABHA serve CDO members.
4) Devise strategies to enhance outpatient addiction treatment and prevention services for
CDO members. These strategies will be developed in collaboration with sub-contracted
treatment providers, DCMH and other community stakeholders. Collaboration will
occur through the Addictions Subcommittee.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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j. Prevention—Support the substance abuse prevention work of the Deschutes County
Commission on Children & Families (CCF). Invest public funds through projects sponsored
by CCF. Support evidence based projects that reduce at-risk youth behavior and support
healthy family functioning.
1) Increase partnerships with treatment providers.
2) Reduce adolescent alcohol use in Deschutes County.
3) Conduct analysis of beer and wine tax money distributed in Deschutes County.
4) As able, reinvest funds from the CDO in projects that prevent substance abuse.
k. Priority Populations—For the foreseeable future, the department will focus its limited
treatment resources by prioritizing service to specific groups in our community.
1) Youth—In an effort to stem the spread of substance abuse in our community, we will
focus on the prevention and treatment of adolescent alcohol use.
2) Adults—Focus on five populations: a) pregnant women, b) intravenous drug users, c)
families with minor children (child welfare concerns), d) people with a methamphetamine
addiction, and/or e) individuals in the justice system (effective alternatives to
incarceration and opportunities to prevent recidivism).
3) As restricted resources become available, other populations in our community will
receive assistance within those grant guidelines.
9. Public Safety, Including Alternatives to Incarceration
Mental health and substance abuse treatment services and prevention strategies are essential to an
effective public safety and justice system. It is the collective goal of mental health professionals,
the courts, corrections and law enforcement in Deschutes County to ensure access to quality
treatment, prevention and support services for youth and adults with mental illness who impact
the criminal justice system.
“People with mental illness or ‘co-occurring disorders’ exact a high toll on the justice system.
Revenue spent on their care while incarcerated pulls scarce resources away from the justice
system’s primary function—prosecution of criminals. Besides:
• Individuals with mental illness stay in jail longer;
• They are more expensive to maintain;
• Without proper treatment, they pose a high risk of re-offending; and
• They are at high risk for suicide while incarcerated..”22
22Oregon Partners in Crisis.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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The Deschutes County Local Public Safety Coordinating Council and its members endorse a
long-term community effort to develop and implement a public safety and treatment system of
effective programs and projects that range from prevention, early intervention, diversion from
jail, in-jail services, transition planning and post-release services. We intend to provide for public
safety; reduce recidivism; offer viable alternatives to incarceration 23 when beneficial and to better
serve, treat and hold accountable individuals with mental illnesses and/or addiction issues. We
support a comprehensive approach to this effort that includes the following:
a. Primary Target Population(s)—Each program or project offered through Deschutes County
will have a target population clearly identified. Likely examples include people with a
significant mental illness, people with both a mental illness and another co-occurring disorder
or people with a primary presenting addiction.
b. Alternatives to Incarceration Report (2006)—Seek opportunities to develop and expand
alternatives to incarceration at levels that correspond to population increase and the bed
expansion planned for the Deschutes County Jail. Develop a treatment and public safety
system that is balanced and that provides sufficient jail capacity and in-jail health services
(both current and planned) as well as the best possible behavioral health services 24 pre- and
post-adjudication. The Report’s priorities will be advanced, where possible, along with the
current jail expansion effort. Resources needed.
c. Collaboration—Develop a lasting and formal partnership through the Local Public Safety
Coordinating Council to address the criminalization of the mentally ill and to plan and carry
out core strategies and programs.
d. System Development—Emphasize a systems approach to improvements in programs,
services and practices used to address the issues associated with mental illness and
addictions.
e. Diversion
1) Crisis and Intensive Outreach—Reduce unnecessary hospitalizations and incarceration
through prevention and early intervention. Sustain the County’s Community Assessment
(Crisis) Team and Mobile Crisis Team for assessment and crisis intervention; expand the
Community Support Services Team for intensive wrap-around services to high-need
clients (includes treatment and connection to programs and supports).
2) Coordination and Referral to Medical Center—Work closely with Cascade Healthcare
Community and other hospital systems. Assure appropriate referrals and coordination of
services. Increase the justice system’s awareness of hospital and County roles, services
and capacities.
3) Sage View—Support successful operation and availability of this secure (short-term)
crisis stabilization, treatment inpatient psychiatric center for eligible individuals including
Oregon Health Plan members and indigent County residents. Resources needed.
23Alternatives to incarceration are defined as those services and strategies offered prior to incarceration, strategies that are
implemented within a jail stay as part of a more comprehensive case plan, and services offered through Deschutes County for
people released from jail and intended to prevent further incarceration.
24Behavioral health services are defined as a combination of mental health and addiction screening, assessment, treatment, case
management and other support services offered by and through the resources of Deschutes County.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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4) Psychiatric Emergency Services at St. Charles Medical Center—Assure sufficient access
to short-term stays at the hospital for assessment and stabilization. Five-bed hold room
unit opened in 2006. DCMH Crisis Team continues to provide daily assistance.
f. Crisis Intervention Training (CIT)—In cooperation with local law enforcement, Cascade
Healthcare Community and NAMI of Central Oregon, offer CIT as an evidence based
practice, increasing the ability of first responders to work with people with mental health or
addiction issues. If that is not feasible given limited resources; offer an abbreviated
introduction to mental illness and local services. Assisted Deschutes County Sheriff in
offering an eight-hour training (2007) for field officers and jail staff. Trained Bend Reserve
Police Academy. Trainings in 2008 will include Redmond Police, Crook County Sheriff and
Oregon State Police. Long-term, offer periodic trainings for officers from all Central Oregon
agencies. Coordinate project with Sheriff and Police Chiefs. Note: The 2007 legislature
passed a law requiring DPSST (Oregon Police Academy) to offer a training for new officers;
efforts should be made to coordinate with DPSST and to complement that curriculum locally.
g. Family Drug Court and Drug Court—In partnership with the courts and treatment providers,
administer (through the County or other entity) grants to sustain the Family Drug Court and
develop an adult Drug Court if feasible. Coordination occurs through the Circuit Court.
1) Family Drug Court—Prioritize families with minor children. Since inception (fall, 2006),
the court has the capacity to help 25 adults and their minor children (currently 42,
January, 2008). Resources needed.
2) Evaluation—Completed two initial evaluations of the Family Drug Court to determine
benefit and opportunities for improvement and/or expansion. Ensure an annual
evaluation process through the most appropriate group.
3) Expansion Long-Term—Expand the Drug Court to serve adults in need of addiction
treatment. Resources needed.
h. Mental Health Court—With courts and program partners, sustain and expand this treatment
court as an effective alternative for County residents with a mental illness who commit
(primarily) non-person misdemeanors and some felonies. Note: Participation requires the
concurrence of the District Attorney, the individual and the Court. Deschutes County Mental
Health services: assessment, treatment, case consultation. Expand the court in 2008-2009
from 12 members (2007) to up to 25 members. Continue to expand the court in conjunction
with jail expansion, as resources allow. Resources needed.
i. County Parole and Probation Specialization—Continue availability of specialized personnel
with expertise and a mental health caseload. Note: FTE increased to 1.5 in 2007. Beneficial
to increase FTE as caseload expands. Expand this capacity further in conjunction with jail
expansion. Resources needed.
j. Multi-Disciplinary Case Coordination—Convene a regular meeting of jail, parole and
probation, mental health, hospital staff to coordinate services for people who frequently use
the services of multiple systems. Initiated in 2007.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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k. Jail Services
1) Perform services through jail staff (Sheriff’s Office) including assessment, medication
and stabilization, particularly of seriously and persistently mentally ill population.
Challenges that must be addressed include:
• The cost of psychotropic medications as part of an inmate's health care;
• Jail stays for this population longer than stays for any other jail population; and
• The lack of mental health treatment in the jail facility itself.
2) Assure DCMH staff availability for crisis assistance. Needed hospitalizations are
accomplished cooperatively between jail and mental health staff.
3) Convene a regular meeting with representatives of the courts, hospital, parole and
probation, and the jail to develop a shared plan for managing the care and custody of
alleged mentally ill persons who are in custody of law enforcement agencies. The parties
have reviewed policies for intervention with inmates with mental illness.
4) Within HIPAA and other confidentiality requirements or limitations, develop methods to
better share client information between DCMH, Deschutes County Jail health care staff
and similar Juvenile Community Justice staff for the purpose of ensuring continuity of
health care and reinstatement of benefits. Seek assistance of County Legal Counsel in
establishing a viable process.
5) Offer support for the efforts of the Sheriff’s Office to develop a specialized unit as part of
the 2011 jail expansion. Offer to assist in the related design and program development to
assure effective services, and case consultation and referral post release. The role of
mental health will be determined by the Sheriff’s Office with resources a key
consideration in what can be offered by DCMH.
l. Bridge Program—Expand and sustain community re-entry services for adults with co-
occurring disorders in the jail and the community corrections system in Deschutes County.
Participate actively, where appropriate, with the Sheriff’s Office and Parole and Probation in
the Reach In Program. Acquire dedicated resources to develop a team of at least three
professionals to offer case management, treatment and support services. A second position
was added in 2008, including capability to treat. Reduce recidivism and improve functioning
in the community through housing and job assistance, treatment, medication management and
other help. Note: Significant expansion needed at time of jail expansion. One of two current
positions is not sustainable long term. Resources needed.
m. Juvenile Services—(This section was provided by Juvenile Community Justice.) Deschutes
County Juvenile Community Justice operates a secure detention facility for juveniles under
the supervision of the Juvenile Court, or juveniles with detainable law enforcement charges
who are awaiting a Court disposition. The decision to detain a youth is a serious one and
must comply with Oregon Revised Statute guidelines.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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While not participating in a formal study or technical assistance project regarding detention
decision practices and developing alternatives to detention, the Juvenile Community Justice
department constantly seeks to monitor and improve its use of detention to ensure the safest
and most cost efficient ways to protect the public and reduce recidivism. As of this writing, a
needs analysis is being done to ascertain the need for emergency shelter resources, as an
alternative to detention for eligible youth awaiting court arraignment and disposition.
Other challenges and needs being addressed in relation to effective use of detention include:
1) Ensuring sustainable funding for Functional Family Therapy, a family-based treatment
model with the specific aims of reducing recidivism and preventing out-of-home
placement, as well as sibling delinquency prevention.
2) Youth offenders with treatment-specific needs who await placement for long periods of
time in detention due to lack of immediate treatment availability and/or a safe placement
option in the home. These include offenders with serious mental health disorders and
sexual offenders awaiting residential treatment.
n. Supervised Housing—As recommended by Adult Parole and Probation, seek resources to
offer transitional, supervised housing for people with mental illness who are diverted from
the justice system or are seeking to re-enter the community. The goal is to offer safe, stable
housing for clients and to prevent recidivism. This need became more apparent with the 2004
closure of Park Place (a crisis respite facility operated by DCMH). Parole and Probation has
developed a transitional housing option (2007) to replace lost space at the reopened Work
Release Center. Services (monitoring, supervision, case management and treatment) are
needed for residents in this housing.
o. Psychiatric Security Review Board (PSRB)—Improve this program locally with additional
staff, services and housing options. Four additional PSRB secure beds are expected in
Deschutes County in 2010. Seek State assistance in educating the community regarding
PSRB processes and guidelines as well as the County's role in the revocation process.
Establish a method to better inform the jail of PSRB individuals residing in Deschutes
County. County hosted 2006 and 2008 meetings for educational purposes. Increase
coordination with public defenders. Continue offering (County PSRB Coordinator)
testimony to the courts when appropriate on PSRB cases. Continue work with law
enforcement on roles and responsibilities during the revocation process. Note: Deschutes
County has continued to have 10-12 clients under PSRB supervision (2008 figures are
comparable to 2005) living in this community. These individuals may be from Central
Oregon or elsewhere in this state.
p. Addictions Treatment—In 2008 and in cooperation with the Deschutes County Sheriff’s
Office, expand addictions treatment for people involved in the justice system. Expanded
Bridge Program will also increase access to service for people with a serious mental illness
needing dual diagnosis treatment. The development of the Family Drug Court has also
expanded access to addiction treatment for qualified families.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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10. Developmental Disabilities Services
a. eXPRS Payment System—This system now provides for direct payment for subcontracted
services and will expand this spring to include payment for case management. This will be
the first step in the new direction that the State is taking to pay counties for services provided.
b. Case Management and Crisis Resolution—Continue to advocate for the expansion of the
regional program to add new local resources to allow individuals to remain in the community
and have their needs met. Continue the increase in funds for case management services to
meet the need of the growing population. The program is required to serve all eligible county
residents; that population has increased by 13%.
c. Family Support—Continue offering goods and services to high-need children and their
families; expand whenever possible. The number of families served has increased 22% in the
past two years through a one-time use of funds to help families on the wait list. 2006-2007 56
families served; 2005-2006 46 families. Wait list has increased from 35 to 47 families in two
years. Resources needed.
d. Residential Options and Community Resources—Increase options for people with disabilities
to remain in their homes and community. Recruit, train and monitor more foster home
options for adults and children. In the past two years, five new foster homes were developed
in the county for medically fragile children and adults, and adults with behavioral challenges.
Develop two new residential resources in the community over the next four years. The
biggest challenge is to help providers recruit, train and maintain the staffing needed.
e. Brokerage Services—The State has increased funding for clients to enter Brokerage services
for the next 18 months. Even at the increased rate, we will still have at least 40 people
waiting for services as of July, 2009, when the Staley lawsuit mandates that all eligible clients
have access to Brokerage services 25. Continue to make the State aware of this shortfall. State
resources needed.
f. Lifespan Respite Services (Regional Program)—Successfully advocated for improvements in
State system and more State funding to improve the quality of life for clients and families and
to prevent costly out-of-home placements. With new State funding, expanded the coordinator
position to full time. In addition to coordinating the program in Crook, Deschutes and
Jefferson counties, the coordinator provides consultation to Harney County to improve their
program.
g. Client and Family Self-Advocacy—Continue to offer training opportunities to support people
in acting as advocates and working to make the community more accessible to people with
disabilities. Support clients in attending community forums and planning groups (e.g.,
transportation planning).
h. Regional Services Program—Recently added five new non-crisis placements in Central
Oregon. Planning for five additional placements by 2009. Hire a regional development
specialist (funds secured) to work with providers and advocates to identify barriers to
expansion and to create solutions.
25The Staley lawsuit settlement requires that all eligible individuals must be enrolled into brokerage services by age 18 as of
July 1, 2009.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
Page 43
APPENDIX 1: FINANCIAL PLAN 2008-2011
Account Description
Budget
FY 2007-08
91.46
Projected
FY 2007-08
95.46
Projected
FY 2008-09
101.28
Projected
FY 2009-10
95.28
Projected
FY 2010-11
95.28
BUDGETED AND ACTUAL REVENUES
Beginning Net Working Capital 2,900,000 2,876,903 2,750,000 1,924,857 1,245,729
State GrantA 3,794,861 4,662,823 5,179,808 5,283,405 5,389,073
ABHA 2,326,940 2,326,940 2,771,800 2,827,236 2,883,781
Other State, Grant & Patient Revenue 1,709,078 1,750,146 1,441,014 1,438,960 1,452,831
General FundB 1,462,516 1,462,516 1,525,899 1,571,676 1,618,826
Other Transfers InC, D 428,193 428,193 453,825 488,289 524,165
FUND RESOURCES TOTAL 12,621,588 13,507,521 14,122,346 13,534,423 13,114,405
BUDGETED AND ACTUAL EXPENDITURES
Personnel ServiceE, F, G 7,226,067 7,488,426 8,350,821 8,427,980 8,933,659
Community Contracts 1,750,700 1,925,700 1,942,754 1,949,608 1,988,600
County Indirects 819,265 819,265 917,128 935,471 954,180
Materials and Services 1,243,043 1,284,020 1,436,686 1,425,535 1,454,046
Capital Outlay 100 - 100 100 100
Transfers Out—Project Development 150,000 150,000 150,000 150,000 150,000
Contingency 1,432,413 - - - -
FUND REQUIREMENTS TOTAL 12,621,588 11,667,411 12,797,489 12,888,694 13,480,585
Beginning Working Capital
Carryforward
2,900,000 2,876,903 2,750,000 1,924,857 1,245,729
Historical Under Spending vs. Budget
on Personnel and Materials
700,000
909,890
600,000
600,000
600,000
Projected (Loss) for Period ( 767,587) ( 126,903) ( 825,143) ( 679,128) ( 1,011,909)
Ending Net Working Capital 2,132,413 2,750,000 1,924,857 1,245,729 233,830
Restricted Working Capital - 150,000 150,000 150,000 150,000
Unrestricted Working CapitalH 2,132,413 2,600,000 1,774,857 1,095,729 83,820
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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Notes and Assumptions:
A. Additional permanent State Grant funds of approximately $783,000 per year will begin to be received
mid-way through the 2007-08 fiscal year. An additional 4.00 FTE was added around January 1,
2008, to provide services with these funds; and an additional 5.32 FTE will be added during the fiscal
year 2008-09 budget process.
B. Assumes County General Fund contribution increases of 0.6 for fiscal year 2008-09, and a 3%
increase for fiscal years 2009-10 and 2010-11.
C. "Other Transfers In" represents funds transferred from DCMH's other two County budgeted funds
(Funds 270 and 280). This account has traditionally been used for the transfer of dollars from Fund
270 and 280. Fund 270 is the depository fund for all our OHP dollars received through ABHA
(recommended government budgeting practices from the GFOA), and Fund 280 is where we budget
and administer our CDO. When developing our annual budgets, we use a conservative estimate of
how much income will be available to fund operations in Fund 275. As a result, excess dollars can
build up in these two funds.
D. State Grant and Administrative Fee are increased 2% each year, except where specifically otherwise
noted.
E. Annual salary increases are calculated using a 6.5% annual increase: 3% is the anticipated COLA
increase, and the other 3.5% is our department's average annual step increase. Salary and benefit
increase appears less due to a reduction of FTE in projected years and current staff who have reached
the highest step in their classification.
F. With the intent of remaining conservative in forecasting, PERS contributions are maintained at the
current rate of 19% for fiscal years 2008-09, 2009-10 and 2010-11.
G. No additional expenditures have been included in projections for any impact resulting from the salary
study the County is planning.
H. It is our intent to keep the unrestricted fund balance equal to or greater than the amount needed to pay
for one month of operations, although fiscal year 2010-11 presents a problem and must be addressed.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
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APPENDIX 2: DESCHUTES COUNTY GOALS AND OBJECTIVES
County Mission: Enhancing the Lives of Citizens
by Delivering Quality Services in A Cost-Effective Manner
Items that may relate to this Mental Health Strategic Plan are bold and italicized.
1. Integrate Deschutes County public safety and prevention functions into a continuum of services that
meet the needs of citizens.
1.1. Continue to explore and determine funding levels for public safety functions (including
expanded jail, alternatives to incarceration, 911, DA, Courts, etc.)
1.2. Lead and coordinate efforts in community disaster and pandemic planning and work with
the business community and non-profit community on business recovery planning.
1.3. Facilitate implementation of allowed alternatives for addressing groundwater problems in south
county.
1.4. Explore alternative funding and service delivery options for prevention and treatment
services while maintaining access to those services.
1.5. Determine which County health and human services are being duplicated by non-
governmental organizations in order to improve service delivery.
2. Deschutes County staff has the knowledge, skills, resources and tools necessary to deliver top-quality
public services.
2.1. Identify priority training needs and sourcing programs to meet those needs.
2.2. Provide internal leadership development opportunities.
2.3. Review and as necessary, revise administrative policies.
2.4. Ensure that the work environment is safe, conducive to productivity and free of harassment.
2.5. Create recognition program for employees.
3. Ensure the effective and efficient stewardship of the County’s natural and built resources.
3.1. Develop a north county campus possibly in conjunction with other non-profit and public
entities.
3.2. Evaluate space needs and plan for projected growth for 911, Sheriff, Parole and Probation, and
other departments as necessary.
3.3. Employ best natural resources practices in the management of County lands.
3.4. Update the County’s comprehensive plan, addressing and integrating rural development,
preservation and transportation planning.
3.5. Develop long-term maintenance plans for County facilities.
4. Provide services that meet the needs of the citizens within budgetary constraints.
4.1. Establish goals and objectives that are consistent with the public’s needs, as we understand
them.
4.2. Develop and implement action and communication plan of the results of the employee
survey.
4.3. Use customer/employee satisfaction data to inform and impact the next budget process.
4.4. Continue to foster a positive environment of customer service within the County.
Deschutes County Mental Health Strategic Plan 2008-2013 May, 2008
Page 46
5. Foster strong, accessible partnership and accountability with employees, customers, community
partners and all citizens.
5.1. Enhance two-way communication mechanisms between County Commissioners,
Administration, and employees, so staff continues to feel free to communicate honestly with
leadership in order to improve accountability and involvement.
5.2. Enhance two-way communication between County leadership and public and community
partnership.
5.3. Define and communicate cultural values and attributes essential to the County.
6. Ensure fiscal responsibility in all aspects of County operations.
6.1. Continue to explore and implement alternative funding sources for road maintenance and
construction.
6.2. Remain competitive in salary and benefits.
6.3. Create cost-effective county-wide procurement standards that encourage sustainable practices.
6.4. Review reserves strategy and develop contingency policies.
6.5. Explore opportunities for combined service delivery with other governmental agencies to save
money for the public.
6.6. Prior to launching a new program or service, demonstrate that the County is the best provider as
a matter of course.
- End of Plan -
For more information regarding this Strategic Plan, please contact:
Scott Johnson, Director
Deschutes County Mental Health
2577 NE Courtney Drive, Bend, Oregon 97701
(541) 322-7502 or scott_johnson@co.deschutes.or.us